Cornelius Brown v. Reynal Caldwell

We summarize the facts in the light most favorable to Brown, the party opposing summary judgment. Johnson v. Dominguez, 5 F.4th 818, 824 (7th Cir. 2021). Brown first noticed pain from a hernia in his groin in 2016 while he was incarcerated at Stateville Correctional Center in Joliet, Illinois. Staff there gave him a hernia belt. In April 2017, Brown transferred to Menard Correctional Center in Menard, Illinois. Dr. Reynal Caldwell was a doctor at Menard, and he and Brown dispute how involved Dr. Caldwell was in Brown's care. Although Dr. Caldwell denied treating Brown, Brown asserted in a declaration that he saw Dr. Caldwell in spring of 2017 to complain of pain from his hernia and constipation. Brown said he asked Dr. Caldwell for surgery, and Dr. Caldwell responded that the hernia was not big enough to require surgery and they had to wait until the hernia became incarcerated (no longer able to be pushed back in or "reduced") or strangulated (incarcerated and cutting off blood supply) before he could refer Brown for surgery. Dr. Caldwell provided Brown with a hernia belt and pain medication. When Brown complained that these were not helping, Dr. Caldwell responded that he had given Brown all the treatment he needed and Brown was "going to have to learn to live with some discomfort until surgery became appropriate."

In February 2018, Brown was transferred to Pontiac Correctional Center in Pontiac, Illinois. By this point, he had two hernias—the inguinal hernia in his groin and an umbilical hernia near his navel—that were each slightly bigger than the size of a grape. On his arrival, a physician assistant saw Brown for his complaints of hernia pain. The physician assistant prescribed a painkiller and fiber supplement and told Brown he did not need surgery. Brown asserted that by this point, the pain from his hernias prevented him from lifting weights or working his job in the prison kitchen. Brown then brought his concerns to Cheryl Hansen, a nurse practitioner, starting in November 2018. He told her he continued to experience pain and constipation from his hernias. She noted that his hernias were still reducible, and she prescribed the same fiber supplement. In December 2018, she again noted that his hernias were reducible when he complained of pain. Hansen told Brown his hernias were not big enough to refer for surgery and that she could not recommend him for surgery until his hernias became strangulated. Hansen prescribed Brown another painkiller, though Brown had told her that medication had not previously alleviated his pain. When Brown saw other nurses during this period and complained of his hernia pain, they continued to provide pain medication and fiber supplements. In spring of 2020, Hansen renewed Brown's permit for a hernia belt. When he explained that he could not climb to the top bunk because of the strain it caused on his hernias, Hansen approved a lower bunk permit.

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Brown testified that he told Hansen his hernias were painful and asked for surgery, but she again said his hernias were not big enough for surgery.

In early 2021, Brown saw an outside urologist for an assessment of testicular swelling. The urologist noted Brown's two reducible hernias and recommended surgery to determine whether the hernias were causing Brown's testicular discomfort. Based on this recommendation, a prison doctor referred Brown for an evaluation by a general surgeon, who recommended surgical repair. Wexford Health Sources, Inc.—the prison's contractor—approved the surgery, and Brown's hernias were repaired in May 2021. Brown had already filed this lawsuit in October 2019, alleging that Dr. Caldwell, Hansen, and Wexford violated the Eighth Amendment when they declined to provide surgical treatment for his painful hernias. In particular, he alleged that Wexford had an unconstitutional policy of always refusing surgical treatment of reducible hernias. The defendants eventually moved for summary judgment and the district court granted that motion. The court reasoned that even if Dr. Caldwell had been involved in Brown's care, he and Hansen were entitled to summary judgment because the undisputed medical evidence demonstrated that reducible hernias do not generally pose a serious risk of harm. The court also concluded that Brown had not offered evidence to show that Hansen or Dr. Caldwell acted with a sufficiently culpable state of mind because he had demonstrated only disagreement with their medical opinions. The court similarly determined Wexford was entitled to summary judgment on Brown's Monell claim because Brown offered no evidence of a practice or custom that violated his rights. See Monell v. Dep't of Soc. Servs., 436 U.S. 658, 694 (1978). On appeal, Brown first argues that the district court erred in granting summary judgment for Hansen because his complaints of pain provided evidence of a serious medical need that Hansen ignored by continuing to prescribe ineffective painkillers. To withstand summary judgment, Brown was required to provide evidence that Hansen was deliberately indifferent, which requires far more than showing potential malpractice or negligence and demands proof from which a jury could find she subjectively knew of and disregarded a substantial risk of harm. See Farmer v. Brennan,

511 U.S. 825, 837 (1994). We afford great deference to a medical provider's treatment decisions unless they were so inadequate as to demonstrate an absence of professional judgment. See Stewart v. Wexford Health Sources, Inc., 14 F.4th 757, 763 (7th Cir. 2021). Brown failed to produce evidence that would allow a reasonable factfinder to overcome this deference and find deliberate indifference. Hansen asserted that she did

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not recommend surgery based on her professional judgment that the hernias remained small and reducible and her belief that Brown did not complain of any symptoms or complications that would demonstrate a need for surgery. Although persisting with ineffective treatments can be evidence of deliberate indifference, Brown provided no evidence that conservative, non-surgical treatment of his hernia pain with painkillers, fiber supplements, a hernia belt, and a low bunk permit was so inadequate that a reasonable jury could find Hansen was not, in fact, exercising her professional judgment. See Johnson v. Dominguez, 5 F.4th at 825-26. Brown may understandably have preferred the permanent solution of surgery sooner, instead of treating only the symptoms as they arose. But the Constitution entitles a prisoner only to adequate medical care, not the specific care he desires. See Johnson v. Doughty, 433 F.3d 1001, 1013-14 (7th Cir. 2006).

Next, Brown argues that the district court erred by entering summary judgment for Dr. Caldwell because Brown's testimony and medical records—including a page signed "Caldwell"—are evidence from which a reasonable jury could find Dr. Caldwell was personally involved in his care. But Brown does not engage with the district court's determination that even if Dr. Caldwell was involved in his care, there was no evidence from which a jury could conclude he acted with deliberate indifference. For the same reasons as Hansen, a reasonable jury could not find on this record that Dr. Caldwell's early non-surgical treatment of Brown's hernias was a serious departure from accepted professional judgment. See Johnson v. Dominguez, 5 F.4th at 825-26. Finally, Brown argues that he provided evidence from which a jury could find that Wexford had a practice or custom of denying surgery for reducible hernias to save money. But a Monell claim requires that the plaintiff first identify an underlying constitutional violation, and Brown has not done so. See Johnson v. Prentice, 29 F.4th 895, 905 (7th Cir. 2022). In any event, this court has previously concluded that Wexford's hernia policy (which states that "patients with stable abdominal wall hernias are not, in general, candidates" for surgery), "leaves no room for a reasonable jury to find" that the policy blocked prisoners from obtaining surgical correction of their hernias if medical providers exercise their professional judgment. Wilson v. Wexford Health Sources, Inc.,

932 F.3d 513, 521-22 (7th Cir. 2019). The evidence here, too, shows that the providers' professional judgment, rather than any policy or custom, was the moving force behind their decisions to delay (but ultimately allow) surgical repair of Brown's reducible hernias.

AFFIRMED

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